Maryland health insurance exchange stumbles out of the gate

Amy Davis, Baltimore Sun

Becca Pearce, executive director of the Maryland Health Benefit Exchange, and Dr. Josh Sharfstein, Secretary of the Maryland Department of Health and Mental Hygiene, are prepared for the first day of enrollment for the new health exchanges.

Becca Pearce, executive director of the Maryland Health Benefit Exchange, and Dr. Josh Sharfstein, Secretary of the Maryland Department of Health and Mental Hygiene, are prepared for the first day of enrollment for the new health exchanges. (Amy Davis, Baltimore Sun)

Andrea K. Walker and Scott Dance, The Baltimore Sun

Bill Kammerzell of Annapolis hoped to enroll in an insurance plan under health reform first thing Tuesday morning but the state's website crashed.

The state marketplace where the uninsured could start buying health plans began having problems immediately after its scheduled 8 a.m. launch. Delays continued all day with people still unable to get onto the site by early evening.

The exchange was among many across the country with opening day hiccups.

"Thank you for visiting Maryland Health Connection," read a notice at the bottom of the website. "We are experiencing connectivity issues. Please visit the site again at 12 noon."

The site finally found life again at about 12:30 p.m., although another note cautioned people about slowness because so many were trying to gain access and people still reported problems.

State officials had warned about the possibility of glitches. The first day's problems were caused by a logjam of people trying to create accounts on the site, said Maryland Health Secretary Joshua Sharfstein. At one point, about 1,000 people a minute were trying to create accounts, he said.

"I think that we expected there would be some things on the first day that could create road blocks and our job is to remove those road blocks," Sharfstein said.

Kammerzell, 62, took the delay in stride, despite his eagerness to buy insurance that will cover his $900 medicine to treat low testosterone. He did some research and believes he can get a plan with a lower deductible than he now pays and also will qualify for subsidies to help pay for it.

"I figured this would happen," he said. "There are all kinds of people trying to get on here. The site is open 24 hours. I'll buy it at 2 a.m. if I have to."

It was a rough start for health reform, or Obamacare, across the country as exchanges in numerous states hit bumps. Enrollment in health plans under the controversial landmark legislation began despite a federal government shutdown prompted by a battle over Republican efforts to delay its start.

Most people who get health insurance through their jobs won't see a change under Obamacare. But millions of uninsured, including 800,000 in Maryland, will have access to insurance through the state exchange — or pay a penalty if they choose not to buy it. Supporters of the measure say that when everyone gets regular care, it will drive down health costs.

The exchange glitch provided fodder for opponents to health reform. Republican Congressman Andy Harris said he was among those who tried to log on to the Maryland Health Connection to compare premium prices, but was unable to connect. He called it a "bad omen."

"They've had three and a half years to prepare for this; I can't understand why on the rollout day for Maryland, Marylanders can't even find out how much this insurance is going to cost," Harris said.

A federally-run exchange for consumers in 36 states began posting error messages for consumers in at least 25 of them soon after the system opened for enrollment, citing online traffic as a reason for the difficulties.

An Obama administration official said experts were aware of the issue and were working on it. The Department of Health and Human Services directed consumers to call centers and local community organizers to seek information.

Federal and state officials had warned earlier in the week that the exchanges could experience technical difficulties. Maryland set up a command center of about 20 people to immediately address any problems.

Sharfstein said testing was done on the site prior and that the shutdown was unexpected. Technicians slowed access to the sign-up portion of the site, while they tried to fix the problem, Sharfstein said. He wasn't sure when work would be completed.

The bright side is that many Marylanders seem to have interest in the plans, Sharfstein said. By 4:30 p.m., the state had received 50,000 unique views to the website and more than 300,000 page views.

Evergreen Health, a new insurance co-op started by former Baltimore health commissioner Peter Beilenson, decided not to enroll people on the first day because of the potential for problems. They have scheduled appointments with about 100 people to help begin enrolling later this week.

"We wanted to make sure everything was up and running smoothly," Beilenson said. He cautioned that people shouldn't be too critical of the mishaps, noting it took years before the federal Medicare program became what it is today.

At the offices of Healthy Howard Inc. in Columbia, about 25 people had gathered at 8 a.m. to get help enrolling in insurance plans. All had insurance through a program for low-income people operated by the group. That program will end in January and enrollees will have to get plans through the exchange. Its clients likely will qualify for the expanded Medicaid or private plans with subsidies.

The staff quickly switched gears after the site didn't work. They began signing people up with paper applications and asking people to come back later in the week.

Roseline Mushi of Laurel was ready to enroll at Healthy Howard, but rescheduled to come in later this week. The 55-year-old found herself without insurance in 2010 when she lost her job as a nursing assistant. She then got coverage through Healthy Howard for $50 a month. Since getting the coverage, she has improved her diet with the use of a health coach, lost weight and stopped taking medicine for high blood pressure.

"I wanted to come here early and take this opportunity to get health insurance," she said. "I know what it's like to be without health insurance. People die because they don't have health insurance."

Manuel Dias Ribeiro and his wife Givanilda Dias Ribeiro filled out a paper application for insurance at Healthy Howard. The pair remember several years ago when they didn't have insurance and got a bill for $140,000 for a surgery their young daughter underwent. They eventually got a charity to pay it, but said they never want that feeling again.

The state expects about 150,000 of the 800,000 uninsured Marylanders to buy insurance from the exchange in the first year. Another 100,000 are expected to gain coverage through an expansion of Medicaid.

Maryland Health Connection operates much like a travel or other online shopping websites and allows people to search 45 plans offered by six insurers. People also can buy insurance by phone or visit enrollment offices throughout the state.

Sharfstein said a call center experienced problems Tuesday with people being able to hear workers, but that the problem was fixed. About 1,000 people had called by late Tuesday afternoon.

State health officials said they expect many will window shop on the first day and might not purchase plans until closer to the end of the enrollment period in March.

Melanie Jackson, a restaurant server from Columbia, wants to compare prices before buying on the exchange. She wants to see how much it will cost for insurance from her employer if she were to take on full-time hours.

"I need to do some homework before I decide," said the 47-year-old with four kids.

In Bel Air in Harford County, the non-profit Seedco set up an table on Main Street to pass out information on health reform. Many who stopped already had insurance.

Others weren't quite sure how Maryland Health Connection might help them, but were eager to know more. Adam Robicheaux, a 22-year-old Bel Air resident, came from his job at the Sunny Day Café across the street to learn more because "you need insurance to do certain things in life."

Robicheaux is insured through a state program called Primary Adult Care, members of which will be shifted to more comprehensive coverage through the state's Medicaid program. He wasn't aware of that change, but said he wanted to find affordable insurance with good coverage after having taken a few trips to the hospital in recent years.